Many Black Americans remain uninsured due to challenges with Medicaid.

• Some Americans, particularly people of color, have been left behind by recent changes to Medicaid programs aimed at closing the health coverage gap in the U.S.
• A report from KFF revealed that in 2022, 10% of Black Americans were uninsured, compared to 6.6% of white Americans.
• According to Jenn Wagner, a director at the Center on Budget and Policy Priorities, the largest factor contributing to the racial coverage gap is the states that have not expanded Medicaid under the Affordable Care Act.

Some Americans, particularly people of color, have been left behind by recent changes to Medicaid programs aimed at closing the health coverage gap in the U.S.

During the Covid pandemic, the number of Americans under age 65 who enrolled in health coverage increased by 3.4 million, according to a KFF report. This rise in insured rates was partly due to the Medicaid and marketplace provisions of the Affordable Care Act.

As the global health crisis subsided and Medicaid coverage expansions were delayed in certain states, the number of insured individuals decreased, and Black Americans continued to be disproportionately uninsured compared to white Americans, according to KFF.

In 2022, Black Americans were 1.5 times more likely to be uninsured than white Americans, while American Indian or Alaskan Native people were 2.9 times more likely to be uninsured than white counterparts. Hispanic Americans were 2.7 times more likely to be uninsured.

"According to Jenn Wagner, a director at the Center on Budget and Policy Priorities, the main reason for the racial coverage gap is the states that have not expanded Medicaid under the Affordable Care Act. These states have a higher population of Black individuals who are unable to access Medicaid coverage because they do not meet the eligibility criteria within their state."

Not all states have expanded Medicaid coverage to people at lower income levels who may not be covered by private insurers, as per KFF.

In states that haven't expanded Medicaid, uninsured adults who don't meet the requirements for coverage but still fall under the poverty line are left with few options.

Nearly half of Black Americans under 65 were insured through an employer or private insurer in 2022, while nearly 40% were insured through Medicaid or another public option, according to KFF.

The U.S. Bureau of Labor Statistics reports that Black unemployment rates are consistently higher than the national average and other groups, meaning fewer Black people have access to health insurance through employers. In January, Black unemployment ticked up slightly to 5.3%, compared with a national average of 3.7% and a white unemployment rate of 3.4%.

According to Samantha Artiga, a director at KFF, while most Black people are in families with full-time workers, they are less likely to have private health coverage compared to their white counterparts. This is because they are more likely to be in low-income jobs that may not offer health coverage.

In states that haven't expanded Medicaid, 13.3% of non-elderly Black Americans are uninsured, compared to 7.3% in states that have adopted the expansion, according to KFF.

The automatic reenrollment provision of Medicaid ended in March 2023, leaving millions of Americans to proactively reenroll themselves, resulting in a significant increase in uninsured rates. Many people were unaware of the changes and saw their coverage lapse.

""The renewal process is facing numerous administrative barriers, which are becoming increasingly apparent, resulting in people losing coverage despite not being ineligible or falling into the coverage gap, due to not receiving the form or the state not processing the timeline," Wagner stated."

At least 17.4 million individuals have been disenrolled from Medicaid or Children's Health Insurance Program coverage since March, while over 35 million people had their coverage renewed. However, 41 million renewals are still pending or not yet due, according to KFF.

Since its founding in 1967 by four Black women, community health centers such as West Oakland Health have been working to address the coverage gap. According to Robert Phillips, CEO of WOH, the center observed a decrease in patients after the conclusion of continuous enrollment.

"The drop in Medicaid patients was precipitous," Phillips said.

Phillips and his team started contacting their Medicaid patients, and he stated that patients have been coming back after being informed about the necessity to renew their coverage.

"Phillips stated, "We want to clarify that individuals are still eligible for coverage despite the extra effort required.""

The East Bay Area of California has five WOH locations that cater to minorities and low-income households in need of affordable healthcare. A majority of WOH's patients are Black and are covered under Medicaid, as stated by the company.